Hirsutism

Hirsutism is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Presence of excessive terminal (coarse, pigmented) hair of body and face, in a male pattern
  • May be present in normal adults as an ethnic characteristic or may develop as a result of androgen excess
  • Often seen in polycystic ovary syndrome (PCOS) which is characterized by hirsutism, acne, menstrual irregularities, and obesity
  • System(s) affected: dermatologic, endocrine, metabolic, reproductive

Epidemiology

Prevalence
5–10% of reproductive age women

Etiology and Pathophysiology

  • Hirsutism is due to increased androgenic (male) hormones, either from increased peripheral binding (idiopathic) or increased production from the ovaries, adrenals, or body fat.
  • Exogenous medications can also cause hirsutism.

Genetics
Multifactorial

Risk Factors

  • Family history
  • Ethnicity—increased in Ashkenazi Jews and Mediterranean backgrounds
  • Anovulation
  • Obesity

General Prevention

Women with late-onset congenital adrenal hyperplasia (CAH) should be counseled that they may be carriers for the severe early-onset childhood disease.

Commonly Associated Conditions

  • PCOS: the most common cause of premenopausal hirsutism (1)
  • Insulin resistance, common
  • Prolonged amenorrhea and anovulation, common
  • Emotional distress and depression, common
  • Acne, common
  • Central obesity
  • Hypothyroidism/hyperthyroidism, rare
  • Hyperprolactinemia, rare
  • Risk for endometrial hyperplasia or carcinoma, rare
  • Virilization (rapid onset, clitoromegaly, balding, deepening voice) (2)
  • Cushing syndrome: characterized by moon facies, striae, hypertension, rare
  • Acromegaly, rare
  • Vitamin D deficiency

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